Hany G Fahmy, FRCS, FACS, Mohamed A Abdelwahab, Alaa Taha. Royal Commission Medical Center, Yanbu Industrial, K.S.A
INTRODUCTION: Retroperitoneal sarcoma represents approximately 12-15% of all sarcomas and less than 0.5% of all neoplasia. Radiotherapy and chemotherapy still do not represent valid therapeutic alternatives; therefore complete surgical resection is the only potential curative treatment modality for retroperitoneal sarcomas. The ability of complete resection of a retroperitoneal sarcoma with tumor grading remains the most important predictor of local recurrence and disease-specific survival. In a patient with a large fibrosarcoma and associated hypoglycemia, assays for insulin-like activity (ILA) were found to be high in the extract of tumor tissue, while insulin was not detected in significant concentration neither in the same extract nor in his serum. Laparoscopic surgery represents an alternative technique for radical resection of such tumors as a minimally invasive rather than traditional surgery. Only few cases were reported in the literature.
CASE REPORT: We report a rare case of 53 years old Filipino gentleman presented to emergency department unconscious due to hypoglycemia .The patient was resuscitated, recovered and admitted for further investigations. Multiple Hypoglycemic attacks recurred during admission. Initial investigations were within average normal except for serum glucose value of 35 mg (2.0 mmol/L). His TSH, glucagon, and fasting cortisol levels were within the normal range, and his serum insulin and C-peptide levels were undetectable. We could detect hypokalemia (serum potassium, 2.3 mEq/L) in his serum. He tested negative for the anti-insulin antibodies. His abdominal ultrasound as well as his computed tomography scans showed the presence of a large retroperitoneal tumor (15 cm×12 cm×7 cm) with a heterogeneous contrast effect. A glucose supplement was required to maintain the plasma glucose level within normal limits during which complete resection of the tumor which was performed laparoscopically. The procedure was performed using three ports.
The sarcomatous mass was completely resected by the use of a harmonic scalpel with clipping of the main vascular blood supply. Patient passed through a smooth postoperative period with minimal wound pain and did not show any further hypoglycemic attacks. Pathological diagnosis of retroperitoneal solitary fibrosarcomatous tumor was confirmed.
CONCLUSION: Diagnosis of such hypoglycemia inducing Retroperitoneal Fibrosarcoma represents great challenge especially when patients presents only with hypoglycemia and no other abdominal symptoms, management using minimal invasive technique to resect and remove such tumors from the retroperitoneal region shows superiority in recovery and limitation of complications when done by experienced surgeons.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86967
Program Number: P170
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster